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r11anME• 1171797 VGRI VnndrAD ACORD- CERTIFICATE OF LIABILITY INSURANCE OATS0 YYI 8/11112120114 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the poilcy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER BB &T Insurance Services of Orange County 2400 Katella Avenue Ste 1100 Anaheim, CA 92806 IJ NAMEA T Terri Amsbury PAr " "c. "ri Ea: 714 941.2936 Arc Ne; 877-297.9259_ EMAIL tamsbu bbandt.com Aooftess: tamsbury@bbandt.com INSURER S,AFPORWNG CDV£RAGE O NAICp INSURER A: Sentinel Insurance Company, Ltd 11000 INSURED INSURERS: Hartford Accident & Indemnity 1 22357 Lynn Capouys Inc. 17992 Mitchell South, Suite 110 Irvine, CA 92614 INSURER C: PERSONAL &ADVEVA.IRY INSURER E: INSURER E: GENETR L AGOREGATE INSURER F: GEN'LAOOREGAMUMITAPPLIESPER: POLICY 28T L- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REOUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSA LTR TYPE OF INSURANCE NOOL INSK SUB Wye POUCYNUMBER _ POLI EF jMMi0,01YYYY1 pOLICY3 p MWOONY LIMITS A OENEBALLIAMLITY X GDM MERDU GENERAL LIASIJTY DLAIM$idADE � OCCUR 72SBAKN6524 07/1012014 071101201 EACH OCCURRENCE $2000i ,0 00 p AMGGSTr NT I9 pL➢ ,le $1000000 MEDEXP n pne crson) $10,000 PERSONAL &ADVEVA.IRY _ s2000000 GENETR L AGOREGATE s4,000,000 GEN'LAOOREGAMUMITAPPLIESPER: POLICY 28T L- PRODUCTS- COMPRJPAOG $4,000,000 $ A AUTOMORILELUMMLITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X AUTOS WNED 72UECAH1867 07/20/2014 07/20/201 __ Eaa COMBINED IN�T s1,000,000 8001YINJURY(Perperspn) S BODiLYNJURYIPeraccMelA) $ pQOPr UPMAGE Ldeell $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMEiAADE 72SBAKN6524 07/ 10/2014 07/101201 EACH OCCURRENCE $1000000 AGGREGATE $1,000,000 DED I X RETENTION$10000 S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERlEXECUTIVEQ OFFICERIMEMBER E %CLUDEDR y IMandat.q In NH) IIye9. d..db.4edw DESCRIPTION OF OPERATIONS W. NIA 72WECRR0814 081'0112014 08/01/209, X WC STATU- OTH• EL.EACHACCIDENr $1000000 EL. DISEASE- EA EMPLOYEE $1000000 EL.DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATION$ I LOCATIONS /VEHICLES (Allech ACORO 101, Additional Remarks Schedule, if more space Is required) The City of Santa Ana, its officers, employees, agents, volunteers and representatives are added as Additional Insured per pages 10.97 of coverage form SS0008 0405 attached. Coverage is primaXpa dRar -LyvED A5 T® T ®RIO insurance maintained by the additional insured shall not contribute. HALL T 1111 SSIBI City f Santa A Public Works SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE y Ana THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Agency M-36 ATTN: Marilyn Boothe ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 1988 Santa Ana, CA 92792 AUTHORIZED REPRESSENTTATIVEt _ ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD W2806712/11,112683393 TLAMS N